P013: Fetal brain blood flow assessment: a 3D power Doppler study

Abstract

Objective: AVMVG, although rare, is associated with significant risk of perinatal mortality and neurodevelopmental delay. We report the prenatal findings in a case of AVMVG, including the recently developed imaging modality of 3D color-Doppler angiography (CDA) to characterize the vascular anatomy of the lesion. Case: A 31-year-old woman, gravida 3 para 1, was referred at 34 weeks after the detection of an AVMVG. Her previous history was significant for a previous stillborn, which prompted regular scans and Doppler ultrasound during the current pregnancy. At 34 weeks, a midline, supratentorial anechoic area measuring 29 × 21 × 19 mm was found in the fetal brain, confirmed by color-Doppler ultrasound as vascular in nature. At referral, we confirmed the above findings. In addition, the superior sagittal sinus was enlarged (‘‘comet tail’’ sign), the neck vessels were mildly dilated and there was mild cardiomegaly but no other signs of cardiac insufficiency. 3D CDA (Voluson 730Expert, GE Medical Systems) was also used to characterize the vascular pattern of the lesion. Multiple feeding vessels were identified, which were not seen with conventional 2D color-Doppler ultrasound. Subsequent MRI confirmed the presence of an AVMVG and prominent vessels both inferiorly and anteriorly coursing around the corpus callosum, but not cerebral structural anomalies. Serial follow-up scans were performed weekly to monitor the cardiovascular status of the fetus. At 37 weeks, an elective Caesarean section was performed, delivering a male infant weighing 3358-g and with Apgar scores of 9–9. The infant was transferred for neurosurgical evaluation and is awaiting embolization of the lesion. Conclusion: 3D CDA may allow a better depiction of those vascular anomalies affecting the fetus than MRI. In this particular case of AVMVG, MRI was not as informative as 3D CDA, suggesting that the first line of investigation should be 3D CDA rather than MRI.